8 Things Doctors Tell Their Friends About Periods

It's the stuff nobody ever covered in seventh-grade health class (and somehow never comes up in your yearly ob/gyn visits either). The insider knowledge from these top M.D.s will change how you greet this monthly visitor.

"Friends often ask me how much bleeding is too much, and I usually say, 'How many tampons or pads do you go through on your heaviest day?' Most have no idea. My suggestion: Start tracking that number using the Notes tool in your phone or an app like iPeriod. Because if you soak through a pad or tampon every hour for several hours, your gynecologist needs to know. Heavy bleeding could signal a number of problems, including a blood-clotting disorder or hypothyroidism. It's also important to know what's typical for your cycle: If one month your heaviest day only requires a panty liner and the following month the bleeding that used to happen over a five-day span is now concentrated into one, that's something to tell your doc too. Changes in bleeding can be flashing neon signs that you're in perimenopause, the time—typically in your 40s, but as early as your 30s—when shifts in estrogen and progesterone become more erratic. Ignoring your suddenly unpredictable period doesn't solve anything; discussing your symptoms with your gyno will." —Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale School of Medicine in New Haven, CT

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DON'T WORRY, YOU'RE NOT ALSO GETTING SICK

"Over drinks one night, a friend asked why she always seems to have a cold at the same time as her period. Truth is, a lot of women experience cold or flu-like symptoms when their period starts: congestion, nausea, achiness, fatigue. That's likely due to prostaglandin, the same bugger that causes cramps and diarrhea. Prostaglandin is an inflammatory chemical; in fact, your body releases it, along with histamine, during an allergic reaction. I told my friend to take 3,000 milligrams of fish oil daily; it contains omega-3 fatty acids, which have anti-inflammatory properties that can help quiet that response. And unlike medications like ibuprofen, it's fine—healthy, even—to take long-term: It won't bother your gut, and the benefits are endless." —SARA GOTTFRIED, M.D., AUTHOR OF THE HORMONE RESET DIET

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YOUR PERIOD IS NO EXCUSE TO EAT #ALLTHECHOCOLATE

"One of my girlfriends recently said, 'I turn into a chocolate monster around my period.' She asked if it was because she was deficient in something—if her body was trying to tell her she needed it. I told her there's a theory that a heavy period can result in lower levels of magnesium, and since chocolate is rich in the mineral, you might be able to argue that you desire it more. But then came the bad news: It's more likely that those cravings are all in your head—it's habit! I told her when she does indulge to at least reach for a square or two of the high-quality dark stuff. That way, you're getting antioxidants along with the sugar rush. And steer clear of milk chocolate, which is fatty and can cause bloating and worsen PMS symptoms." —FAHIMEH SASAN, D.O., ASSISTANT PROFESSOR OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE SCIENCE AT THE ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI IN NEW YORK CITY

IT MIGHT NOT COME BACK AS SOON AS YOU GO OFF THE PILL

"A friend's daughter recently told me she was ready to start her family, and she was concerned that her period hadn't returned since she went off the Pill two months earlier. I explained that it often takes three to six months to get your period back—sometimes longer. It's not because the Pill does anything unsafe; it simply prevents your body from making the hormones involved in ovulation and menstruation, and it can take time for that system to return to normal. I told her to see her doctor if her period wasn't back within six months. If she had been 35 instead of 25, I would have suggested she go after three months, because anything more than that could cut into her window of fertility. I also recommended that she start taking a prenatal vitamin right away, as the Pill can interfere with the absorption of some B vitamins that are essential for a healthy pregnancy." —Mache Seibel, M.D., author of The Estrogen Window and professor of obstetrics and gynecology at the University of Massachusetts Medical School in Worcester

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NEVER ASSUME THAT IT'S JUST CRAMPS

"A while back a friend and colleague called to ask my advice: She was worried because she had awful cramps and heavy bleeding, but her doctor wasn't sure why. Since she's in her 40s, I suggested she ask him for an ultrasound to check for fibroids. These tumors are often associated with pelvic pain, cramps, and heavy bleeding, and they're really common in women over 35. Several months later she called me back and said, 'You were right! I have fibroids.' We've known for some time that fibroids run in families, but what we've learned recently is that they're shockingly prevalent in African-American women. One study found that overall, 15 percent of women between the ages of 18 and 30 have fibroids without symptoms, but the rate in black women is nearly 26 percent. So if you are African-American, check your family history, talk to your doctor about reducing your risk, and ask for an ultrasound if you ever develop painful periods." —James Segars, M.D., director of the Division of Reproductive Science and Women's Health Research and professor of gynecology and obstetrics at Johns Hopkins University in Baltimore

GET AHEAD OF THE BLOAT

"My daughter's friends are always asking me stuff about their periods. Recently one called and asked what she could do about bloating. I told her, 'The week leading up to your period, take 100 to 200 milligrams of vitamin B6, 200 IUs of vitamin E, and 1,000 IUs of evening primrose oil every day.' We're not entirely sure why this trio works, but it seems to have diuretic properties (meaning, it makes you pee), and it may block the activity of the hormone prolactin, one potential cause of bloating. Plus, primrose oil is rich in gamma-linolenic acid, an omega-6 fatty acid, and it's possible that some women become deficient in fatty acids around their period. Whatever the reason, I'd say 60 to 70 percent of my friends feel better once they try my 'vitamin cocktail,' and it's perfectly safe." —MARY JANE MINKIN, M.D.

YOUR WORKOUT CAN WAIT

"Last week in barre class, a friend mentioned that the routine feels so much harder during her period. I told her I can relate—I'm a runner, and I love to push myself, but I just can't when it's that time of the month. There's a reason so many women don't feel as strong or active when they're menstruating: Working muscles need oxygen to produce energy, and when you bleed, you lose a lot of iron, the mineral that helps to deliver oxygen to your tissues and support muscle function. The result is that you feel exhausted just climbing stairs. I told my workout buddy to take it easy when she's on her period, and eat plenty of iron-rich foods like grass-fed red meat and dark leafy greens. In fact, on your heaviest day, I'd say go ahead and trade your workout for a steak and some red wine." —SARA GOTTFRIED, M.D.

TAMPONS AREN'T GOING TO KILL YOU

"Not long ago, there was a news story about a model who had her leg amputated due to toxic shock syndrome (TSS), the life-threatening bacterial infection that can occur if you leave a tampon in for too long. When a friend asked me if she should be freaked out, I told her there's really no reason to worry. TSS—which has symptoms like a high fever, aches, vomiting, nausea, and a rash—is not very common. The incidence rate is about three cases per 100,000 people. In fact, in nearly 10 years, I've never seen a single case. I asked a few colleagues who've been doctors longer, and they haven't seen a patient with TSS either. The standard advice is still true, though: Don't wear a tampon for more than four to eight hours, and choose only the absorbency you need for your flow." —FAHIMEH SASAN, D.O.